To evaluate the diagnostic accuracy of fine needle aspiration cytology in comparison to histopathological findings in patients with Thyroid Nodules. This study carried out at King-Husain Medical Center [Royal Medical Services] from February 2012 to September 2013. Records of 103 patients treated surgically for thyroid nodules were reviewed. The patients who had pre operative fine needle aspiration cytology as first line of the evaluation and the final post operative histopathology report available were included in the study. All cases underwent surgery and histopathology results were compared with the cytology results. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were calculated. Of the 103 patients, 83 female 80.6%, 20 male 19.4%. The cytological diagnosis was made according to following categories: Benign, Suspicious, Malignant and Inadequate sampling. Among 40 [Benign cases] , 37 were benign and 3 turned out to be malignant. Among 38 cases from [suspicious, 8 were benign and 30 were malignant. Out of 21 patients from [Malignant] group, 19 were malignant and 2 were benign. Among four patients from the [Inadequate sampling group] , 3 turned out to be benign and one was malignant. The overall results showed a sensitivity of 92.4%, specificity of 80%, and positive predictive value of 83.1%, negative predictive value of 90% and diagnostic accuracy of 86.4%. Fine needle aspiration cytology is a minimally invasive procedure, simple, reasonable approach and the preferred initial diagnostic test in all patients with thyroid nodule. Fine needle aspiration cytology has high sensitivity in picking up malignancy in thyroid and also has high diagnostic accuracy in the evaluation of thyroid nodules and we should improve specificity